Low disease activity state in SLE linked to reduced health care costs
Achieving a low disease activity state in systemic lupus erythematosus that is maintained for 50% or more of the time is associated with significantly reduced out-of-pocket hospital costs for patients, according to findings published in Arthritis Care & Research.
“The need for treat to target (T2T) approaches to systemic lupus erythematosus (SLE), based on validated T2T endpoints, has recently been highlighted,” Ai Li Yeo, MBBS, FRACP, of the Monash University School of Clinical Sciences in Victoria, Australia, and colleagues wrote. “In response to this need, a Lupus Low Disease Activity State (LLDAS) definition has been proposed, and its attainment has been shown to be associated with protection from damage accrual and improved health-related quality of life (HRQoL).”
They added, “Adoption of T2T endpoints requires evidence of cost benefit as well as improved health outcomes, but no data on the impact of T2T endpoint attainment on health care utilization and cost have been reported.”
To analyze the link between low disease activity in SLE and health care costs among patients, Yeo and colleagues studied data from the Asia Pacific Lupus Collaboration, a multinational prospective cohort collected at Monash Health, in Melbourne, Australia. Specifically, the researchers focused on patients diagnosed with SLE who had at least two visits to the Monash Lupus Clinic from October 2013 to June 2016. A total of 200 patients with SLE, representing 357.8 person-years of observation, met the criteria and were included in the study.
The researchers collected baseline demographic and medication information, as well as disease activity, defined using the SLE Disease Activity Index (SLEDAI)2K, physician global assessment and flare index. In addition, they accessed health care use and cost data from hospital information systems. Low disease activity was defined as a physician global assessment of 1 or less, receiving 7.5 mg or less of prednisone per day and optimal standard immunosuppressive agents. Data analysis included multivariable linear regression.
According to the researchers, 42% of included patients demonstrated a history of lupus nephritis, and lupus-related damage was present in 57.3% at the beginning of the study. The mean annual direct health-care cost per patient was $7,413 per year. Following multivariable analysis, increased health care cost was associated with the presence of organ damage at baseline (P =.009) and corticosteroid use (> 7.5 mg to 15 mg per day, P = .02; > 15 mg per day, P < .001). Low disease activity that had been maintained for at least 50% of the patient’s time as associated with a 25.9% reduction in annual medical costs (P = .04).
“While baseline organ damage and glucocorticoid use were associated with increased direct health care utilization and cost in SLE, LLDAS was associated with significantly reduced direct health care utilization and cost,” Yeo and colleagues wrote. “While future research could be directed at broader cost estimations and assessment of patterns of LLDAS attainment, these findings provide additional support for the utility of LLDAS as a T2T endpoint in SLE.” – by Jason Laday
Disclosure: Yeo reports no relevant financial disclosures. See the full study for additional authors’ disclosures.